General Surgery Coding Alert

Question: How should I code a transendoscopic duodenal stent placement?

Iowa Subscriber

Answer: The correct code for endoscopic duodenal stent placement depends on the base procedure, whether an upper gastrointestinal endoscopy (EGD) or an esophagoscopy.

For the EGD, report 43266 (Esophagogastroduo­denoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)). For stent placement during an esophagoscopy, report 43212 (Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)).

Basics: Surgeons may insert stents endoscopically to hold open the lumen of the gastrointestinal tract at necessary sites, such as to preserve the esophageal lumen for inoperable cancer cases, or for the duodenum as you mentioned, or in the colon. CPT^® provides specific codes for stent placement in all those areas, such as the following:

• 45327 (Proctosigmoidoscopy, rigid; with transen­doscopic stent placement (includes predilation))
• 45347 (Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-di­lation and guide wire passage, when performed))
• 45389 (Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post-dilation and guide wire passage, when performed)).